The drugs don’t work they just make you worse

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The Verve released this song in 1997 in their album ‘Urban Hymns’. I was living in Dundee at the time and can remember walking down Perth Road singing this as I met my friend Phil who has walking in the opposite direction, singing the same song to himself.

It is funny that so many years later, this has become much of what I do – explaining to patients and their relatives about the respective harms related to the drugs they are prescribed.

In my world, the most common medicines that I review, in older people, are those prescribed for Blood Pressure.

The control of Blood Pressure, has been one of the great successes of the 20^th Century – it has been responsible for preventing strokes, heart attacks and kidney failure, it has changed heart failure, which was a terrible acute condition, into a chronic disease; these drugs have prevented blindness, amputation and, probably dementia.

Blood Pressure is complicated and suffice it to say, that too much is no good and too little can be worse, indeed, too low Blood Pressure generally is what happens when we are not alive.

We don’t as yet, in healthcare, have a good system for ensuring that medicines are reviewed and stopped.

When a GP meets an older patient, perhaps someone who is 90, living in a nursing home, who is otherwise well and their blood pressure is OK, the general tendency is to leave things as they are – there is a fear, which is inherent within all of medicine that doing something when nothing is wrong, will make matters worse, whether that is stopping or starting a medicine, although the latter, given the inherent bias in medicine towards ‘when in doubt, act’ alongside subliminal pharmaceutical cheer-leading, usually leaves medicines in place.

While the list of medicines that do good is very long, those which potentially do harm is even longer, particularly when older people are involved; those who have lost weight as they age, or whose kidney and liver function has declined or proportion of body-fat, or metabolism fallen.

Patients often take medicines when they think they are doing them harm; some patients will stop, others will forget to take them, most will however comply, fill the prescription each month, follow the instructions and feel ropey – if they didn’t take the medicines, would there not be a risk that they might feel worse? And, why would my doctor give me something that is making me feel bad? (& Thank goodness for the end of paternalism in medicine…)

And this is part of the joy of my job – de-prescribing, undoing the burden of medicine that has somehow aligned ageing with medicine and the more the better.

Not all medicines cause problems, it is just, that we, those who are doing the prescribing, need to bear in mind, the power of drugs, which is beyond their chemical effect, particularly in the very old; they have a power to make us think magically about what is good and what is bad.